People management, anyone?

‘If you do health in India, you have to work in Uttar Pradesh, that’s where the challenge and the numbers are,” says Bill Gates, co-chair of the $37-billion Bill and Melinda Gates Foundation (BMGF), who left on Friday after a three-day visit.

That holds true more than ever if the focus is on population and women and child health. Uttar Pradesh is India’s most populous state where 166 million of India’s 1.28 billion people live, shows Census data. Here, 4 million of the country’s 27 million babies are born each year, raising India’s headcount continually and exponentially.

“I certainly don’t believe in controlling population, families should decide how many kids they have,” says Gates, who has three children. “The foundation is not involved in abortions, or anything coercive at all. But the general trajectory is that with improved healthcare and opportunity, families choose to have less children,” says Gates. The BMGF is the world’s largest philanthropic organisation that has committed over US$1 billion for health and development in India.

Every year, India adds more people than any other nation in the world. In fact, the individual population of some of its states is equal to the total population of many countries. For example, the population of UP almost equals that of Brazil, while that of the second most populous state, Maharashtra, equals Mexico’s population.

That’s the reason why Gate’s one-day trip to Lucknow included a visit to a slum teeming with clueless couples looking for contraception options, and, yes, lots of children. “The slum there was an analogue of this book I just read, Behind the Beautiful Forevers. It was typical slum, chaotic, with piles of plastic bottles, with some nice houses, some huts. People have hopes for their children, and want the best for them,” says the tech innovator and the world’s second richest man, referring to Pulitzer Prize-winning journalist Katherine Boo’s bestseller on the hopes and dreams of people living in Annawadi, a squatter slum neighbouring of Mumbai’s swank new international airport.

More than 50% of India’s population is below the age of 25 and over 65% below the age of 35. About 72.2% of the population lives in some 638,000 villages and the rest 27.8% in about 5,480 towns and urban agglomerations. “When people are given healthcare and opportunities, they have smaller families. The top 10% of the population in developing countries have the fewest kids, while the bottom 30% have the most. It’s established data,” says Gates.

The Centre, on its part, is allocating more funds to bridge critical infrastructure and human resources gaps in 264 districts with weak health indicators. Women health workers are already delivering contraceptives — R 1 for a pack of three condoms, R 1 for a month’s supply of Oral Contraceptive Pills and R 2 for emergency contraceptive pills at people’s doorstep in 233 districts across 17 states.

The BMGF now plans to duplicate the outreach successes that eliminated polio in India to women and child health, such as vaccinations and contraceptive services to help couples have fewer children. “Unlike the rest of the world, India has the scientific and business potential to be part of the solution to its own challenges. It’s quite unique in that aspect,” says Gates. The solutions are all there, it’s the implementation that needs to be accelerated to keep India’s demographic curve on track.